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Initiative helps hospital slash VAT rate in PICU

Monday June 17, 2013
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An initiative that combines a multidisciplinary healthcare approach with a range of preventive measures could cut the rate of ventilator-associated tracheobronchitis among children in intensive care by more than half, according to a study.

Historically, VAT infections have not been tracked as closely as ventilator-associated pneumonia, which has been monitored by the CDC for more than a decade and is a common target for quality improvement initiatives in hospitals across the country, according to background information in the article, which is published in the June issue of the journal Pediatric Critical Care Medicine.

A program instituted in 2007 at Nationwide Childrenís Hospital in Columbus, Ohio, to prevent VAP in ventilated PICU patients led to a dramatic decline in VAP rates. However, physicians found that many children still required treatment for ventilator-associated airway infections that did meet the CDC criteria for VAP. In 2010, Jennifer Muszynski, MD, a critical care physician at the hospital, and her colleagues decided to adapt the VAP prevention program to study its effectiveness on reducing VAT.

The new plan included a bundle of patient care components. Ventilated patientsí beds were raised to a 30-degree angle at the head, which helps reduce bacteria in the airway. Patients were given an anti-bacterial oral rinse every four hours, and respiratory therapists followed a strict process for suctioning secretions from patientsí mouths and throats. A multidisciplinary team of nurses, physicians and respiratory therapists met regularly to monitor patientsí progress.

After 18 months, the cases of VAT had dropped by 53% compared with pre-intervention rates. Muszynski said the multidisciplinary approach was key to the success of the program, noting that because each team member interacted differently with the patient and brought a unique perspective, barriers to bundle implementation could be identified and solved quickly.

The researchers noted the study is among the first to be published on VAT prevention in pediatric patients. Although there is good information to be mined from the data, Musyznki said it only grazes the surface of the problem.

"We still want to understand why some children get VAT and others donít, or why one child will have a mild case while another gets very sick, even when both have the benefit of the same preventive protocol," Muszynski, also an assistant professor of pediatrics at The Ohio State University College of Medicine, said in a news release.

Read the study abstract: http://bit.ly/10rwJ4w.

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